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Individual

MR. GARRETT JON MODLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.S.,R.D.,C.D.N

Contact information

Practice address
622 LACEY DR, ENDWELL, NY 13760-2545
(607) 321-1135
Mailing address
622 LACEY DR, ENDWELL, NY 13760-2545
(607) 321-1135

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
005584
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
005584
NY
05
925332
NY
Enumeration date
09/22/2011
Last updated
09/22/2011
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